The 2002 Florida Statutes

Title XXXII
REGULATION OF PROFESSIONS AND OCCUPATIONS
Chapter 467
MIDWIFERY

467.001  Short title.

467.002  Legislative intent.

467.003  Definitions.

467.004  Council of Licensed Midwifery.

467.005  Authority to make rules.

467.006  Requirements to practice midwifery.

467.009  Midwifery programs; education and training requirements.

467.011  Licensure by examination.

467.012  Renewal of license.

467.0125  Licensure by endorsement.

467.013  Inactive status.

467.0135  Fees.

467.014  Financial responsibility.

467.015  Responsibilities of the midwife.

467.016  Informed consent.

467.017  Emergency care plan; immunity.

467.019  Records and reports.

467.201  Violations and penalties.

467.203  Disciplinary actions; penalties.

467.205  Approval of midwifery programs.

467.207  Exceptions.

467.001  Short title.--This chapter shall be known and may be cited as the "Midwifery Practice Act."

History.--ss. 1, 3, ch. 82-99; s. 8, ch. 84-268; ss. 4, 5, ch. 91-429; s. 19, ch. 92-179; s. 79, ch. 2001-62.

467.002  Legislative intent.--The Legislature recognizes the need for a person to have the freedom to choose the manner, cost, and setting for giving birth. The Legislature finds that access to prenatal care and delivery services is limited by the inadequate number of providers of such services and that the regulated practice of midwifery may help to reduce this shortage. The Legislature also recognizes the need for the safe and effective delivery of newborn babies and the health, safety, and welfare of their mothers in the delivery process. The Legislature finds that the interests of public health require the regulation of the practice of midwifery in this state for the purpose of protecting the health and welfare of mothers and infants. Therefore, it is unlawful for any person to practice midwifery in this state unless such person is licensed pursuant to the provisions of this chapter or s. 464.012.

History.--ss. 1, 3, ch. 82-99; ss. 1, 8, ch. 84-268; ss. 4, 5, ch. 91-429; ss. 1, 19, ch. 92-179; s. 79, ch. 2001-62.

467.003  Definitions.--As used in this chapter, unless the context otherwise requires:

(1)  "Approved program" means a midwifery school or a midwifery training program which is approved by the department pursuant to s. 467.205.

(2)  "Certified nurse midwife" means a person who is licensed as an advanced registered nurse practitioner under part I of chapter 464 and who is certified to practice midwifery by the American College of Nurse Midwives.

(3)  "Council" means the Council of Licensed Midwifery.

(4)  "Department" means the Department of Health.

(5)  "Intrapartal" means occurring during the process of giving birth.

(6)  "Licensure" means authorization and license granted by the department for a person to engage in the practice of midwifery.

(7)  "Midwife" means any person not less than 21 years of age, other than a licensed physician or certified nurse midwife, who is licensed under this chapter to supervise the birth of a child.

(8)  "Midwifery" means the practice of supervising the conduct of a normal labor and childbirth, with the informed consent of the parent; the practice of advising the parents as to the progress of the childbirth; and the practice of rendering prenatal and postpartal care.

(9)  "Normal labor and childbirth" means the physiological process of a healthy woman giving birth to a healthy infant and expelling an intact placenta, without injury, complications, or undue strain to the mother.

(10)  "Physician" means a person licensed to practice medicine as authorized in chapter 458 or chapter 459.

(11)  "Postpartal" or "postpartum" means existing or occurring subsequent to birth.

(12)  "Preceptor" means a physician, a licensed midwife, or a certified nurse midwife, who has a minimum of 3 years' professional experience, and who directs, teaches, supervises, and evaluates the learning experiences of the student midwife.

(13)  "Prenatal" or "antepartal" means occurring during pregnancy up to the point of onset of labor.

(14)  "Secretary" means the Secretary of Health.

(15)  "Stillbirth" means the death of a fetus of more than 20 weeks' gestation.

History.--ss. 1, 3, ch. 82-99; ss. 2, 8, ch. 84-268; ss. 4, 5, ch. 91-429; ss. 2, 19, ch. 92-179; s. 128, ch. 94-218; s. 74, ch. 98-166; s. 131, ch. 2000-318.

467.004  Council of Licensed Midwifery.--

(1)  The Council of Licensed Midwifery is created within the department and shall consist of nine members to be appointed by the secretary.

(2)  One member of the council shall be a certified nurse midwife. One member of the council shall be a physician who is an obstetrician certified by the American Board of Obstetrics and Gynecology and one family physician certified by the American Board of Family Practice. One member of the council shall be a physician who is a pediatrician certified by the American Board of Pediatrics. Four members of the council shall be licensed midwives. The one remaining member shall be a resident of this state who has never been a licensed midwife and who has no financial interest in the practice of midwifery or in any health care facility, agency, or insurer. The council members shall serve staggered 4-year terms as determined by rule.

(3)  The council shall:

(a)  Assist and advise the department in developing rules relating to: training requirements, including core competencies, for persons training to become licensed midwives; the licensure examination; fees; the informed consent form; responsibilities of midwives; emergency care plans; records and reports to be filed by licensed midwives; and other regulatory requirements developed by the department.

(b)  Assist the department in developing rules to implement s. 467.205, relating to approval of midwifery training programs.

(c)  Monitor and inform the department on the practice of midwifery in other states and countries by persons who are not nurses.

(d)  Educate the public and other providers of obstetrical care about the role of licensed midwives.

(e)  Collect and review data regarding licensed midwifery.

(f)  Recommend changes in the Midwifery Practice Act to the department and the Legislature.

(g)  Address concerns and problems of practicing licensed midwives in order to promote improved safety in the practice of midwifery.

(4)  Members of the council shall serve without pay. The council members shall be entitled to reimbursement for per diem and travel expenses pursuant to s. 112.061.

History.--ss. 1, 3, ch. 82-99; s. 2, ch. 83-265; ss. 3, 8, ch. 84-268; ss. 4, 5, ch. 91-429; ss. 3, 19, 20, ch. 92-179; s. 129, ch. 94-218; s. 62, ch. 95-144; s. 79, ch. 2001-62.

467.005  Authority to make rules.--The department has authority to adopt rules pursuant to ss. 120.536(1) and 120.54 to implement the provisions of this chapter conferring duties upon it. The rules shall include, but not be limited to, the allowable scope of midwifery practice regarding use of equipment, procedures, and medication.

History.--ss. 1, 3, ch. 82-99; s. 8, ch. 84-268; ss. 4, 5, ch. 91-429; s. 19, ch. 92-179; s. 130, ch. 98-200.

467.006  Requirements to practice midwifery.--

(1)  Any person who seeks to practice midwifery in this state must be at least 21 years of age and must be licensed pursuant to s. 464.012 or this chapter.

(2)  A midwife who on October 1, 1992, holds a valid license to practice midwifery in this state may continue to practice midwifery pursuant to the provisions of this chapter except for the provisions relating to collaborative care and to administration of medicinal drugs in s. 467.015(2) and (3). Upon successful completion of additional training requirements, as determined by the council and department, the midwife may practice midwifery in accordance with all provisions of this chapter.

History.--ss. 6, 8, ch. 84-268; ss. 4, 5, ch. 91-429; ss. 4, 19, ch. 92-179; s. 4, ch. 98-130.

467.009  Midwifery programs; education and training requirements.--

(1)  The department shall adopt standards for midwifery programs. The standards shall encompass clinical and classroom instruction in all aspects of prenatal, intrapartal, and postpartal care, including obstetrics; neonatal pediatrics; basic sciences; female reproductive anatomy and physiology; behavioral sciences; childbirth education; community care; epidemiology; genetics; embryology; neonatology; applied pharmacology; the medical and legal aspects of midwifery; gynecology and women's health; family planning; nutrition during pregnancy and lactation; breastfeeding; and basic nursing skills; and any other instruction determined by the department and council to be necessary. The standards shall incorporate the core competencies established by the American College of Nurse Midwives and the Midwives Alliance of North America, including knowledge, skills, and professional behavior in the following areas: primary management, collaborative management, referral, and medical consultation; antepartal, intrapartal, postpartal, and neonatal care; family planning and gynecological care; common complications; and professional responsibilities. The standards shall include noncurriculum matters under this section, including, but not limited to, staffing and teacher qualifications.

(2)  An approved midwifery program shall include a course of study and clinical training for a minimum of 3 years. If the applicant is a registered nurse or a licensed practical nurse or has previous nursing or midwifery education, the required period of training may be reduced to the extent of the applicant's qualifications, as determined under rules adopted by the department. In no case shall the training be reduced to a period of less than 2 years.

(3)  To be accepted into an approved midwifery program an applicant shall have:

(a)  A high school diploma or its equivalent.

(b)  Passed the college level academic scholastic test (CLAST) or taken three college-level credits each of math and English or demonstrated competencies in communication and computation.

(4)  A student midwife, during training, shall undertake, under the supervision of a preceptor, the care of 50 women in each of the prenatal, intrapartal, and postpartal periods, but the same women need not be seen through all three periods.

(5)  The student midwife shall observe an additional 25 women in the intrapartal period before qualifying for a license.

(6)  The training required under this section shall include training in either hospitals or alternative birth settings, or both, with particular emphasis on learning the ability to differentiate between low-risk pregnancies and high-risk pregnancies. A hospital or birthing center receiving public funds shall be required to provide student midwives access to observe labor, delivery, and postpartal procedures, provided the woman in labor has given informed consent. The Department of Health shall assist in facilitating access to hospital training for approved midwifery programs.

(7)  The Department of Education shall adopt curricular frameworks for midwifery programs conducted within public educational institutions pursuant to this section.

(8)  Nonpublic educational institutions that conduct approved midwifery programs shall be accredited by a member of the Commission on Recognition of Postsecondary Accreditation and shall be licensed by the State Board of Nonpublic Career Education.

History.--ss. 1, 3, ch. 82-99; s. 8, ch. 84-268; ss. 4, 5, ch. 91-429; ss. 5, 19, ch. 92-179; s. 24, ch. 94-310; s. 36, ch. 98-421; s. 226, ch. 99-8.

467.011  Licensure by examination.--

(1)  The department shall administer an examination to test the proficiency of applicants in the core competencies required to practice midwifery as specified in s. 467.009.

(2)  The department shall develop, publish, and make available to interested parties at a reasonable cost a bibliography and guide for the examination.

(3)  The department shall issue a license to practice midwifery to an applicant who has graduated from an approved midwifery program and successfully completed the examination, upon payment of the required licensure fee.

History.--ss. 1, 3, ch. 82-99; s. 8, ch. 84-268; ss. 4, 5, ch. 91-429; ss. 6, 19, ch. 92-179; s. 79, ch. 2001-62.

467.012  Renewal of license.--

(1)  The department shall renew a license upon receipt of the renewal application and fee, provided the applicant is in compliance with the provisions of this chapter and rules adopted under this chapter.

(2)  The department shall adopt rules establishing a procedure for the biennial renewal of licenses.

(3)  The department may by rule prescribe continuing education requirements, not to exceed 20 hours biennially, as a condition for renewal of a license. The criteria for continuing education programs shall be approved by the department. Any individual, institution, organization, or agency that is approved by the department to provide continuing education programs to midwives for the purpose of license renewal must demonstrate that such programs comply with the following criteria:

(a)  The programs have clinical relevance to the practice of midwifery;

(b)  The programs are at least 1 clock hour in duration;

(c)  The programs have an organized structure with objectives and expected outcomes; and

(d)  Each presenter, instructor, or facilitator of programs is a recognized professional, such as a physician, nurse, certified nurse midwife, psychologist, or licensed midwife.

(4)  The department shall approve, through the adoption of rules, continuing education programs that meet the criteria of this section and have clinical relevance to the practice of midwifery. Each midwife shall be required to affirm that he or she has the applicable number of continuing education hours for the reporting period as specified by the department.

(5)  A midwife licensed in this state who resides in another state may obtain the continuing education credits required for license renewal by attending a program approved by the agency in the midwife's state of residence which regulates the licensure of health care professionals in that state if such program has clinical relevance to the practice of midwifery.

(6)  A licensed midwife may fulfill up to 5 hours of continuing education credit by providing pro bono services for indigent persons or underserved populations in areas of critical need within the state.

(7)  In order to authorize continuing education credit for pro bono services, the department shall adopt rules requiring that a licensee notify the department of his or her intention of providing these services; the type, nature, and extent of services to be rendered; the location where the services will be rendered; the number of patients expected to be served; and a statement indicating that the patients to be served are indigent.

(8)  Each midwife shall maintain documentation of pro bono service for 4 years after the date the credits are used as a basis for license renewal and shall submit a certified copy of such documentation to the department upon request.

(9)  The department shall audit the files of randomly selected licensees to ensure compliance with this section and with rules adopted under this section. The department may take disciplinary action, as established by rule, against a licensee who fails to maintain the required documentation for continuing education, patient records, and pro bono service or who submits false or misleading information or documentation to the department.

(10)  Any individual, institution, organization, or agency that seeks approval by the department for the purpose of conducting continuing education programs for licensed midwives must apply to the department. The department shall issue a provider number to all approved providers, which number must appear on all documents that relate to each continuing education program conducted by the provider. A provider's approved status remains in effect for the biennium in which such status was granted by the department. The department may renew a provider's approved status if the provider meets the requirements established by the department by rule. An approved provider shall maintain the following records for each continuing education program for 4 years following the licensure biennium during which the program was offered:

(a)  A program outline that reflects the educational objectives of the program;

(b)  The instructor's name;

(c)  The date and location of the program;

(d)  The participants' evaluations of the program;

(e)  The number of clock hours of credit awarded to each participant; and

(f)  A roster of participants by name and license number.

(11)  The approved provider of a continuing education program shall certify the participation of any midwife who completes the program by providing the midwife with a certificate or comparable documentation verifying that the midwife completed the program. The department shall adopt rules that establish what the verification must contain.

(12)  A presenter of a continuing education program may receive the same amount of credit, on a one-time basis, as the program participants. The presenter must have developed the program, been in attendance for the entire program, and received documentation of completion from the approved provider. A licensee may receive up to 3 hours of continuing education credit per biennium for presenting programs.

(13)  The department may audit or monitor programs and review records and program materials given by any approved provider. The department may rescind a provider's approved status or reject an individual program given by a provider if the program does not have clinical relevance to the practice of midwifery, if any false or misleading information is disseminated in connection with the continuing education program, or if the provider fails to conform to and abide by the conditions outlined in the application and rules of the department.

History.--ss. 1, 3, ch. 82-99; s. 88, ch. 83-218; s. 8, ch. 84-268; ss. 4, 5, ch. 91-429; s. 19, ch. 92-179; s. 182, ch. 94-119; s. 5, ch. 98-130.

467.0125  Licensure by endorsement.--

(1)  The department shall issue a license by endorsement to practice midwifery to an applicant who, upon applying to the department, demonstrates to the department that she or he:

(a)1.  Holds a valid certificate or diploma from a foreign institution of medicine or midwifery or from a midwifery program offered in another state, bearing the seal of the institution or otherwise authenticated, which renders the individual eligible to practice midwifery in the country or state in which it was issued, provided the requirements therefor are deemed by the department to be substantially equivalent to, or to exceed, those established under this chapter and rules adopted under this chapter, and submits therewith a certified translation of the foreign certificate or diploma; or

2.  Holds a valid certificate or license to practice midwifery in another state, issued by that state, provided the requirements therefor are deemed by the department to be substantially equivalent to, or to exceed, those established under this chapter and rules adopted under this chapter.

(b)  Has completed a 4-month prelicensure course conducted by an approved program and has submitted documentation to the department of successful completion. The department shall determine by rule the content of the prelicensure course.

(c)  Has successfully passed the licensed midwifery examination.

(2)  The department may issue a temporary certificate to practice in areas of critical need to any midwife who is qualifying for licensure by endorsement under subsection (1), with the following restrictions:

(a)  The Department of Health shall determine the areas of critical need, and the midwife so certified shall practice only in those specific areas, under the auspices of a physician licensed pursuant to chapter 458 or chapter 459, a certified nurse midwife licensed pursuant to part I of chapter 464, or a midwife licensed under this chapter, who has a minimum of 3 years' professional experience. Such areas shall include, but not be limited to, health professional shortage areas designated by the United States Department of Health and Human Services.

(b)  A temporary certificate issued under this section shall be valid only as long as an area for which it is issued remains an area of critical need, but no longer than 2 years, and shall not be renewable.

(c)  The department may administer an abbreviated oral examination to determine the midwife's competency, but no written regular examination shall be necessary.

(d)  The department shall not issue a temporary certificate to any midwife who is under investigation in another state for an act which would constitute a violation of this chapter until such time as the investigation is complete, at which time the provisions of this section shall apply.

(e)  The department shall review the practice under a temporary certificate at least annually to ascertain that the minimum requirements of the midwifery rules promulgated under this chapter are being met. If ¹it is determined that the minimum requirements are not being met, the department shall immediately revoke the temporary certificate.

(f)  The fee for a temporary certificate shall not exceed $50 and shall be in addition to the fee required for licensure.

History.--ss. 7, 19, ch. 92-179; s. 264, ch. 97-103; s. 227, ch. 99-8; s. 132, ch. 2000-318; s. 79, ch. 2001-62.

¹Note.--Substituted by the editors for the word "is" to improve clarity and facilitate correct interpretation.

467.013  Inactive status.--A licensee may request that his or her license be placed in an inactive status by making application to the department and paying a fee.

(1)  An inactive license may be renewed for one additional biennium upon application to the department and payment of the applicable biennium renewal fee. The department shall establish by rule procedures and fees for applying to place a license on inactive status, renewing an inactive license, and reactivating an inactive license. The fee for any of these procedures may not exceed the biennial renewal fee established by the department.

(2)  Any license that is not renewed by the end of the biennium established by the department automatically reverts to involuntary inactive status unless the licensee has applied for voluntary inactive status. Such license may be reactivated only if the licensee meets the requirements for reactivating the license established by department rule.

(3)  A midwife who desires to reactivate an inactive license shall apply to the department, complete the reactivation application, remit the applicable fees, and submit proof of compliance with the requirements for continuing education established by department rule.

(4)  Each licensed midwife whose license has been placed on inactive status for more than 1 year must complete continuing education hours as a condition of reactivating the inactive license.

(5)  The licensee shall submit to the department evidence of participation in 10 hours of continuing education, approved by the department and clinically related to the practice of midwifery, for each year of the biennium in which the license was inactive. This requirement is in addition to submitting evidence of completing the continuing education required for the most recent biennium in which the licensee held an active license.

History.--ss. 1, 3, ch. 82-99; s. 8, ch. 84-268; ss. 4, 5, ch. 91-429; ss. 8, 19, ch. 92-179; s. 183, ch. 94-119; s. 265, ch. 97-103; s. 6, ch. 98-130.

467.0135  Fees.--The department shall establish fees for application, examination, initial licensure, renewal of licensure, licensure by endorsement, inactive status, delinquent status, and reactivation of an inactive license. The appropriate fee must be paid at the time of application and is payable to the Department of Health, in accordance with rules adopted by the department. A fee is nonrefundable, unless otherwise provided by rule. A fee may not exceed:

(1)  Five hundred dollars for examination.

(2)  Five hundred dollars for initial licensure.

(3)  Five hundred dollars for renewal of licensure.

(4)  Two hundred dollars for application, which fee is nonrefundable.

(5)  Five hundred dollars for reactivation of an inactive license.

(6)  Five hundred dollars for licensure by endorsement.

A fee for inactive status, reactivation of an inactive license, or delinquency may not exceed the fee established by the department for biennial renewal of an active license. All fees collected under this section shall be deposited in the Medical Quality Assurance Trust Fund.

History.--ss. 9, 19, ch. 92-179; s. 184, ch. 94-119; s. 7, ch. 98-130; s. 123, ch. 2000-153.

467.014  Financial responsibility.--A licensed midwife shall include in the informed consent plan presented to the parents the status of the midwife's malpractice insurance, including the amount of malpractice insurance, if any.

History.--ss. 10, 19, ch. 92-179; s. 79, ch. 2001-62.

467.015  Responsibilities of the midwife.--

(1)  A midwife shall accept and provide care for only those mothers who are expected to have a normal pregnancy, labor, and delivery and shall ensure that the following conditions are met:

(a)  The patient has signed an informed consent form approved by the department pursuant to s. 467.016.

(b)  If the patient is delivering at home, the home is safe and hygienic and meets standards set forth by the department.

(2)  A midwife may provide collaborative prenatal and postpartal care to pregnant women not at low risk in their pregnancy, labor, and delivery, within a written protocol of a physician currently licensed under chapter 458 or chapter 459, which physician shall maintain supervision for directing the specific course of medical treatment. The department shall by rule develop guidelines for the identification of high-risk pregnancies.

(3)  A midwife licensed under this chapter may administer prophylactic ophthalmic medication, oxygen, postpartum oxytocin, vitamin K, rho immune globulin (human), and local anesthetic pursuant to a prescription issued by a practitioner licensed under chapter 458 or chapter 459, and may administer such other medicinal drugs as prescribed by such practitioner. Any such prescription for medicinal drugs shall be in a form that complies with chapter 499 and shall be dispensed in a pharmacy permitted under chapter 465 by a pharmacist licensed under chapter 465.

(4)  The care of mothers and infants throughout the prenatal, intrapartal, and postpartal periods shall be in conformity with rules adopted by the department pursuant to this chapter and the public health laws of this state.

(5)  The midwife shall:

(a)  Prepare a written plan of action with the family to ensure continuity of medical care throughout labor and delivery and to provide for immediate medical care if an emergency arises. The family should have specific plans for medical care throughout the prenatal, intrapartal, and postpartal periods.

(b)  Instruct the patient and family regarding the preparation of the environment and ensure availability of equipment and supplies needed for delivery and infant care, if a home birth is planned.

(c)  Instruct the patient in the hygiene of pregnancy and nutrition as it relates to prenatal care.

(d)  Maintain equipment and supplies in conformity with the rules adopted pursuant to this chapter.

(6)  The midwife shall determine the progress of labor and, when birth is imminent, shall be immediately available until delivery is accomplished. During labor and delivery, the midwife shall comply with rules adopted by the department pursuant to this chapter, which shall include rules that govern:

(a)  Maintaining a safe and hygienic environment;

(b)  Monitoring the progress of labor and the status of the fetus;

(c)  Recognizing early signs of distress or complications; and

(d)  Enacting the written emergency plan when indicated.

(7)(a)  The midwife shall remain with the postpartal mother until the conditions of the mother and the neonate are stabilized.

(b)  The midwife shall instill into each eye of the newborn infant a prophylactic in accordance with s. 383.04.

History.--ss. 1, 3, ch. 82-99; s. 89, ch. 83-218; s. 8, ch. 84-268; ss. 4, 5, ch. 91-429; ss. 11, 19, ch. 92-179; s. 79, ch. 2001-62.

467.016  Informed consent.--The department shall develop a uniform client informed-consent form to be used by the midwife to inform the client of the qualifications of a licensed midwife and the nature and risk of the procedures to be used by a midwife and to obtain the client's consent for the provision of midwifery services.

History.--ss. 1, 3, ch. 82-99; s. 8, ch. 84-268; ss. 4, 5, ch. 91-429; s. 19, ch. 92-179; s. 79, ch. 2001-62.

467.017  Emergency care plan; immunity.--

(1)  Every licensed midwife shall develop a written plan for the appropriate delivery of emergency care. A copy of the plan shall accompany any application for license issuance or renewal. The plan shall address the following:

(a)  Consultation with other health care providers.

(b)  Emergency transfer.

(c)  Access to neonatal intensive care units and obstetrical units or other patient care areas.

(2)  Any physician licensed under chapter 458 or chapter 459, or any certified nurse midwife, or any hospital licensed under chapter 395, or any osteopathic hospital, providing medical care or treatment to a woman or infant due to an emergency arising during delivery or birth as a consequence of the care received by a midwife licensed under chapter 467 shall not be held liable for any civil damages as a result of such medical care or treatment unless such damages result from providing, or failing to provide, medical care or treatment under circumstances demonstrating a reckless disregard for the consequences so as to affect the life or health of another.

History.--ss. 1, 3, ch. 82-99; s. 8, ch. 84-268; ss. 4, 5, ch. 91-429; ss. 12, 19, ch. 92-179; s. 79, ch. 2001-62.

467.019  Records and reports.--

(1)  The midwife shall mail or submit a completed birth certificate for each birth, in accordance with the requirements of chapter 382, to the local registrar of vital statistics within 5 days following birth.

(2)  The midwife shall instruct the parents regarding the requirement for an infant screening blood test for metabolic diseases as required by s. 383.14 and rules promulgated pursuant thereto, and shall notify the county health department in the county where the birth occurs, within 48 hours following delivery, unless other arrangements for the test have been made by the parents.

(3)  Each maternal death, newborn death, and stillbirth shall be reported immediately to the medical examiner.

(4)  The department shall adopt rules requiring that a midwife keep a record of each patient served. Such record must document, but need not be limited to, each consultation, referral, transport, transfer of care, and emergency care rendered by the midwife and must include all subsequent updates and copy of the birth certificate. These records shall be kept on file for a minimum of 5 years following the date of the last entry in the records.

(5)  Within 90 days after the death of a midwife, the estate or agent shall place all patient records of the deceased midwife in the care of another midwife licensed in this state who shall ensure that each patient of the deceased midwife is notified in writing. A midwife who terminates or relocates to private practice outside the local telephone directory service area of the midwife's current practice shall provide notice to all patients as prescribed by department rule.

(6)  The department shall adopt rules to provide for maintaining patient records of a deceased midwife or a midwife who terminates or relocates a private practice.

(7)  A licensed midwife who is or has been employed by a practice or facility, such as a birth center, which maintains patient records as records belonging to the facility may review patient records on the premises of the practice or facility as necessary for statistical purposes.

History.--ss. 1, 3, ch. 82-99; s. 8, ch. 84-268; ss. 4, 5, ch. 91-429; s. 19, ch. 92-179; s. 144, ch. 97-101; s. 8, ch. 98-130.

467.201  Violations and penalties.--Each of the following acts constitutes a felony of the third degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084:

(1)  Practicing midwifery, unless holding an active license to do so.

(2)  Using or attempting to use a license which has been suspended or revoked.

(3)  The willful practice of midwifery by a student midwife without a preceptor present, except in an emergency.

(4)  Knowingly allowing a student midwife to practice midwifery without a preceptor present, except in an emergency.

(5)  Obtaining or attempting to obtain a license under this chapter through bribery or fraudulent misrepresentation.

(6)  Using the name or title "midwife" or "licensed midwife" or any other name or title which implies that a person is licensed to practice midwifery, unless such person is duly licensed as provided in this chapter.

(7)  Knowingly concealing information relating to the enforcement of this chapter or rules adopted pursuant thereto.

History.--ss. 1, 3, ch. 82-99; s. 8, ch. 84-268; s. 96, ch. 91-224; ss. 4, 5, ch. 91-429; ss. 13, 19, ch. 92-179; s. 57, ch. 2000-318; s. 79, ch. 2001-62.

467.203  Disciplinary actions; penalties.--

(1)  The following acts constitute grounds for denial of a license or disciplinary action, as specified in s. 456.072(2):

(a)  Procuring, attempting to procure, or renewing a license to practice midwifery by bribery, by fraudulent misrepresentation, or through an error of the department.

(b)  Having a license to practice midwifery revoked, suspended, or otherwise acted against, including being denied licensure, by the licensing authority of another state, territory, or country.

(c)  Being convicted or found guilty, regardless of adjudication, in any jurisdiction of a crime which directly relates to the practice of midwifery or to the ability to practice midwifery. A plea of nolo contendere shall be considered a conviction for purposes of this provision.

(d)  Making or filing a false report or record, which the licensee knows to be false; intentionally or negligently failing to file a report or record required by state or federal law; or willfully impeding or obstructing such filing or inducing another to do so. Such reports or records shall include only those which are signed in the midwife's capacity as a licensed midwife.

(e)  Advertising falsely, misleadingly, or deceptively.

(f)  Engaging in unprofessional conduct, which includes, but is not limited to, any departure from, or the failure to conform to, the standards of practice of midwifery as established by the department, in which case actual injury need not be established.

(g)  Being unable to practice midwifery with reasonable skill and safety to patients by reason of illness; drunkenness; or use of drugs, narcotics, chemicals, or other materials or as a result of any mental or physical condition. A midwife affected under this paragraph shall, at reasonable intervals, be afforded an opportunity to demonstrate that he or she can resume the competent practice of midwifery with reasonable skill and safety.

(h)  Failing to report to the department any person who the licensee knows is in violation of this chapter or of the rules of the department.

(i)  Violating any lawful order of the department previously entered in a disciplinary proceeding or failing to comply with a lawfully issued subpoena of the department.

(j)  Violating any provision of this chapter or chapter 456, or any rules adopted pursuant thereto.

(2)  The department may enter an order denying licensure or imposing any of the penalties in s. 456.072(2) against any applicant for licensure or licensee who is found guilty of violating any provision of subsection (1) of this section or who is found guilty of violating any provision of s. 456.072(1).

(3)  The department shall not reinstate the license of a midwife, or cause a license to be issued to a person it has deemed unqualified, until such time as it is satisfied that such person has complied with all the terms and conditions set forth in the final order and that such person is capable of safely engaging in the practice of midwifery.

(4)  The department shall by rule establish guidelines for the disposition of disciplinary cases involving specific types of violations. Such guidelines may include minimum and maximum fines, periods of suspension or probation, or conditions of probation or reissuance of a license.

History.--ss. 1, 3, ch. 82-99; s. 90, ch. 83-218; s. 8, ch. 84-268; ss. 4, 5, ch. 91-429; s. 19, ch. 92-179; s. 266, ch. 97-103; s. 133, ch. 2000-318; s. 79, ch. 2001-62; s. 36, ch. 2001-277.

467.205  Approval of midwifery programs.--

(1)  An organization desiring to conduct an approved program for the education of midwives shall apply to the department and submit such evidence as may be required to show that it complies with s. 467.009 and with the rules of the department. Any accredited or state-licensed institution of higher learning, public or private, may provide midwifery education and training.

(2)  The department shall adopt rules regarding educational objectives, faculty qualifications, curriculum guidelines, administrative procedures, and other training requirements as are necessary to ensure that approved programs graduate midwives competent to practice under this chapter.

(3)  The department shall survey each organization applying for approval. If the department is satisfied that the program meets the requirements of s. 467.009 and rules adopted pursuant to that section, it shall approve the program.

(4)  The department shall, at least once every 3 years, certify whether each approved midwifery program complies with the standards developed under s. 467.009.

(5)  If the department finds that an approved program no longer meets the required standards, it may place the program on probationary status until such time as the standards are restored. If a program fails to correct these conditions within a specified period of time, the department may rescind the approval. Any program having its approval rescinded shall have the right to reapply.

(6)  Provisional approval of a new program may be granted pending the licensure results of the first graduating class.

History.--ss. 1, 3, ch. 82-99; s. 8, ch. 84-268; ss. 4, 5, ch. 91-429; ss. 14, 19, ch. 92-179; s. 79, ch. 2001-62.

467.207  Exceptions.--No provision of this chapter shall be construed to prohibit:

(1)  The practice of midwifery by students enrolled in an approved midwifery training program.

(2)  The establishment of an independent practice by one or more midwives for the purpose of rendering to patients midwifery services within the scope of the midwife license.

(3)  Assistance by any person in the case of an emergency.

History.--ss. 1, 3, ch. 82-99; s. 8, ch. 84-268; ss. 4, 5, ch. 91-429; s. 19, ch. 92-179; s. 79, ch. 2001-62.- 382

64B24-1.001 Purpose.

64B24-1.002 General Description of Agency Organization and Operations.

64B24-1.003 Council’s Official Headquarters.

64B24-1.004 Meetings, Quorum, and Absences.

64B24-1.005 Public Information and Inspection of Records. (Repealed)

The licensure of midwives exists to protect the safe and effective delivery of newborn babies and the health, safety and welfare of

their mothers through appropriate procedures for prenatal, delivery and postnatal care by ensuring that every midwife practicing in

this state meets minimum requirements for safe and ethical practice. This purpose is achieved through the establishment of

minimum qualifications for licensure and through effective discipline for those practitioners who violate the applicable laws or

rules promulgated thereunder.

(1) Throughout these rules the Council of Licensed Midwifery may be referred to as the "council" and the Department of

Health may be referred to as the "department."

(2) The Council of Licensed Midwifery is located within the Department of Health, which shall be responsible for providing

such administrative, secretarial, clerical, investigative and prosecutorial personnel as are determined to be necessary to carry out the

purposes of this chapter. The Executive Director of the council, at the council’s address, is hereby designated as the agent for the

council for the service of process for all matters relating to the council.

The council’s official headquarters is in Tallahassee and the council may be contacted through the Department of Health, Council

of Licensed Midwifery, 4052 Bald Cypress Way, Bin C06, Tallahassee, Florida 32399-3256. Office hours are 8:00 a.m. to 5:00

p.m. Monday through Friday, except for state holidays.

(1) The council shall hold such meetings during the year as it may deem necessary, one of which shall be the annual meeting at

which the chairperson and vice-chairperson shall be elected. The department, the chairperson or a quorum of the council shall have

the authority to call other meetings.

(2) Fifty-one percent (51%) or more of the appointed members of the council shall constitute a quorum necessary to transact

business.

(3) Three consecutive unexcused absences, or absences constituting 50 percent or more of the council’s meetings within any

12-month period shall cause the council membership of the member in question to become void, and the position shall be

considered vacant pursuant to Section 456.011(3), Florida Statutes. For the purposes of this rule, an absence shall be deemed

excused if the council member’s absence is caused by a health problem or condition verified in writing by a physician, or by an

accident or similar unforeseeable tragedy or event, and the council member submits to the Executive Director a statement in writing

attesting to the event and its circumstances prior to the next council meeting.

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64B24-2.001 Licensure to Practice Midwifery.

64B24-2.002 Examination.

64B24-2.003 Licensure by Examination.

64B24-2.004 Licensure by Endorsement.

(1) Persons desiring to be licensed as a midwife shall make application to the department and remit all applicable fees as

required by Chapter 64B24-3, F.A.C. The application shall be made on Form DH-MQA 1051, Application for Midwifery

Licensure, incorporated herein by reference and revised 8/02, which can be obtained from the Council of Licensed Midwifery,

Department of Health, 4052 Bald Cypress Way, Bin C06, Tallahassee, Florida 32399-3256. If incomplete, the application and fees

shall expire 1 year from the date on which the application is initially received by the department. After a period of 1 year a new

application with required fees must be submitted.

(2) The department shall license only those applicants who have completed the application form, remitted the appropriate fees

required by Rule Chapter 64B24-3, F.A.C., and who demonstrate to the department that they:

(a) Are 21 years of age or older;

(b) Meet the requirements for licensure by exam pursuant to Rule 64B24-2.003, F.A.C., or licensure by endorsement pursuant

to Rule 64B24-2.004, F.A.C.;

(c) Have completed a one (1) hour educational course on domestic violence that meets the substantive specifications set forth

in Section 456.031, F.S., as it pertains to the practice of midwifery; and

(d) Have completed a two (2) hour course relating to the prevention of medical errors.

(3) When the department is satisfied that all requirements are met in full, a license to practice midwifery will be issued to the

applicant. The license will remain valid for the remainder of the biennium in which it is issued, unless suspended or revoked by the

department.

The department hereby designates the North American Registry of Midwives’ (NARM) written examination dated after October 1,

1993, as the midwifery licensure examination. Any person desiring to be licensed as a midwife shall apply to the NARM to take the

licensure examination.

Persons desiring to obtain licensure as a midwife by examination shall make application to the department pursuant to Rule

64B24-2.001, F.A.C., and shall evidence compliance of licensure requirements by submitting the following:

(1) An official transcript from an approved midwifery training program specifically setting forth all courses successfully

completed, the date of the applicant’s graduation and the degree, certificate, or diploma awarded;

(2) A written plan for the management of emergencies which meets the requirements of Section 467.017(1), F.S.; and

(3) Documentation of a passing score on the licensure examination designated in Rule 64B24-2.002, F.A.C. Such

documentation shall be sent directly from the NARM.

(1)(a) Foreign trained applicants for licensure by endorsement shall make application to the department pursuant to Rule

64B24-2.001, F.A.C., and shall in addition submit to the department:

1. A valid certificate or diploma from either a foreign institution of medicine or a foreign school of midwifery;

2. A certified translation of the certificate or diploma earned from a foreign institution of medicine or foreign school of

midwifery;

3. The document which renders the foreign trained applicant eligible to practice medicine or midwifery in the country in which

that document was issued;

4. A certified translation of the certificate, diploma or license which renders the foreign trained applicant eligible to practice

medicine or midwifery in the country from which the diploma or certificate was awarded;

5. Clarification of the existence of any deviation as to how the applicant’s name appears on the face of documents in support of

this application;

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6. Evidence of successful completion of the 4 month prelicensure course pursuant to Rule 64B24-4.010, F.A.C.;

7. Evidence of a passing score on the licensure examination; and

8. A written plan for the management of emergencies which meets the requirements described in Section 467.017, F.S.

(b) In determining whether the requirements to hold a certificate or diploma from a foreign institution of medicine or a foreign

school of midwifery are substantially equivalent to the requirements established under Chapter 467, F.S., and these rules, the

department shall consider whether:

1. The curriculum of the foreign institution of medicine or foreign school of midwifery provided both classroom instruction

and core rotations in obstetrics/gynecology for award of the diploma or certificate;

2. The medical education required for award of the diploma or certificate was at least 3 years; and

3. The applicant’s diploma or certificate meets the requirements to render the applicant eligible to practice medicine or

midwifery in the country from which the diploma or certificate was awarded.

(2)(a) Persons trained in another state for licensure by endorsement shall make application to the department pursuant to Rule

64B24-2.001, F.A.C., and shall in addition submit to the department:

1. A current valid unrestricted certificate or license to practice midwifery in another state;

2. Evidence of successful completion of the 4 month prelicensure course pursuant to Rule 64B24-4.010, F.A.C.;

3. Evidence of a passing score on the licensure examination; and

4. A written plan for the management of emergencies which meets the requirements described in Section 467.017, F.S.

(b) In determining whether the requirements to hold a certificate or license to practice midwifery in another state are

substantially equivalent to the requirements established under Chapter 467, F.S., and these rules, the applicant shall submit:

1. A certificate or diploma awarded by a midwifery program which was approved by the certifying body of the state in which it

was located, or an authenticated copy of that certificate or diploma;

2. A copy of the other state’s laws and rules under which the applicant’s certificate or license was issued; and

3. Official transcripts from the midwifery program which document classroom instruction and clinical training equivalent to

the requirements in Rules 64B24-4.004 through 64B24-4.007, F.A.C.

(3)(a) The department shall issue a temporary certificate to practice midwifery in areas of critical need to any applicant who is

qualifying for licensure by endorsement pursuant to subsection 64B24-2.004(1) or (2), F.A.C. The applicant shall submit to the

department:

1. A completed application and the temporary certificate fee required pursuant to Rule 64B24-3.004, F.A.C.;

2. Documentation as required by paragraph (1)(a) or (2)(a) of this rule which will evidence the active pursuit of licensure

through endorsement;

3. Documentation of the area of critical need pursuant to Section 467.0125(2)(a), F.S.; and

4. Name of the individual who will serve as the midwife’s supervisor. This individual shall be a physician currently licensed

pursuant to Chapter 458 or Chapter 459, F.S., a certified nurse midwife licensed pursuant to Chapter 464, F.S., or a midwife

licensed pursuant to Chapter 467, F.S., who has a minimum of 3 years of professional experience.

(b) A temporary certificate issued under this section shall be valid only as long as an area for which it is issued remains an area

of critical need, but no longer than 2 years. A temporary certificate is not renewable.

(c) To ascertain that the minimum requirements of the midwifery rules are being met, temporary certificate holders shall

submit by December 1 each year Form DH-MQA 1052, Annual Report of Midwifery Practice, incorporated herein by reference

and revised 8/01, and can be obtained from the Council of Licensed Midwifery, Department of Health, 4052 Bald Cypress Way,

Bin C02, Tallahassee, Florida 32399-3256.

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64B24-3.001 Collection and Payment of Fees.

64B24-3.002 Application Fee.

64B24-3.003 Examination Fee.

64B24-3.004 Endorsement Fee.

64B24-3.005 Initial License Fee.

64B24-3.006 Temporary Certificate Fee.

64B24-3.007 Active Biennial Renewal Fee.

64B24-3.008 Delinquent Fee.

64B24-3.009 Reactivation Fee.

64B24-3.010 Inactive Status Fee.

64B24-3.011 Duplicate License Fee.

64B24-3.012 Certification of Public Record Fee.

64B24-3.013 Continuing Education Provider Application Fee.

64B24-3.014 Unlicensed Activity Fee.

64B24-3.015 Change of Status Fee.

64B24-3.016 Inactive Renewal Fee.

All licensure fees shall be paid at the time of application, shall be made payable to the Department of Health, and shall be in

accordance with the following rules. Unless stated elsewhere, fees are non-refundable.

The application fee shall be $200.

The examination fee shall be $500. This fee shall be refunded if the applicant is ineligible to sit for the examination.

The endorsement fee shall be $500.

The initial license fee whether by examination or endorsement shall be $500.

The temporary certificate fee shall be $50 and shall be in addition to the fee required for licensure.

The active biennial renewal fee shall be $500.

The delinquent fee shall be $75.

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The reactivation fee shall be $500.

The inactive status fee shall be $100.

The duplicate license fee shall be $25.

The certification of public record fee shall be $25.

The provider application fee shall be $250.

Pursuant to the provision of Section 456.065(3), Florida Statutes, a special fee of $5 shall be imposed upon any initial license or

certificate issued by the agency, as well as upon any renewal of said license or certificate, and shall fund efforts to combat

unlicensed activity.

The fee for processing a licensee’s request to change licensure status at any time shall be $75.

The inactive renewal fee is $500.

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64B24-4.001 Definitions.

64B24-4.002 Approval of Training Program.

64B24-4.003 Acceptance into Training Program.

64B24-4.004 Educational Objectives.

64B24-4.005 Faculty.

64B24-4.006 Curriculum Guidelines.

64B24-4.007 Clinical Training.

64B24-4.008 Administrative Procedures.

64B24-4.010 Four-month Pre-licensure Course.

(1) "Department" means the Department of Health.

(2) "Clinical expertise" means demonstrated proficiency in a specialized area of direct patient care.

(3) "Clinical learning experience" means faculty planned and supervised instruction of students during which students function

in a midwifery capacity with patients.

(4) "Credit hour" means one hour of credit representing 15 hours of classroom teaching or 30 hours of clinical learned

experience.

(5) "Direct supervision" means the physical presence within the patient care unit of a preceptor or faculty member who

assumes legal responsibility for the practice of the student midwife being supervised, and who provides direction and consultation

for the actions of such student midwife in the preceptor or faculty members area of clinical expertise.

(6) "Facility" means any establishment or institution in which students in an approved program obtain clinical learning or

observational experiences.

(7) "Faculty" means the teaching staff in an educational institution who are qualified by education and experience in the areas

which they teach.

(8) "Observational experience" means learning experience planned and directed by program faculty during which students do

not function in a midwife capacity.

(9) "Supervision of students" means oversight and direction of student activities by program faculty who are responsible for

the results of students’ services.

(10) "Three year training program" means not less than 90 credit hours.

(11) "Two year reduced training program" means not less than 60 credit hours.

(12) "Four month pre-licensure course" means not less than 15 credit hours which meets the requirements of subsection

64B24-4.010(4), F.A.C.

(1) Provisional approval shall be granted by the department to an organization to initiate a midwifery training program when it

has presented documentation satisfactory to the department that it meets the following criteria:

(a) The training program shall be conducted in either an accredited public institution, or in a non-public institution licensed by

the State Board of Independent Postsecondary Vocational, Technical, Trade and Business Schools and which is actively seeking

accreditation by a member of the Council on Postsecondary Accreditation. All training programs shall include both classroom

instruction and clinical training;

(b) The time required to complete the training program shall be pursuant to Section 467.009(2), F.S.;

(c) Educational Objectives pursuant to Rule 64B24-4.004, F.A.C.;

(d) Faculty pursuant to Rule 64B24-4.005, F.A.C.;

(e) Curriculum pursuant to Rule 64B24-4.006, F.A.C.;

(f) Clinical Training pursuant to Rule 64B24-4.007, F.A.C.; and

(g) Administrative Procedures pursuant to Rule 64B24-4.008, F.A.C.

(2) Training programs which have been granted provisional approval may be granted full approval upon demonstration to the

department they are in compliance with established standards of the department, and at least 80 percent of the first graduating class

qualified for licensure.

(3) A training program may be placed on probationary status when the department determines that the program falls below

established standards, or fewer than 80 percent of the graduates qualify for licensure. Probationary status shall be on an individual

basis for a specified period of time not to exceed 12 months.

(4) The department shall rescind approval of any training program which fails to meet standards established by this chapter, or

fails to make satisfactory progress for corrections of deficiencies within the probationary time period designated by the department.

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(5) Any training program having its approval rescinded shall have the right to reapply.

(6) The department shall, at least once every 3 years, audit the approval status of all training programs to determine if the

program is in compliance with established standards.

To be accepted into a department approved midwifery training program, the program shall evidence that the applicant has:

(1) A high school diploma, or its equivalent; and

(2) Passed the College Level Academic Scholastic Test (CLAST), or has taken and received a passing grade in three college

level credits each of math and English, or can demonstrate competencies in communication and computation by passing the

College Level Equivalent Proficiency (CLEP) test in communication and computation.

(1) The administration and faculty of the training program shall formulate and adopt educational objectives which ensure that

the curriculum guideline requirements will be met as specified in Rule 64B24-4.006, F.A.C. These objectives shall be based on a

clearly stated philosophy which shall be in keeping with currently accepted midwifery standards and which are consistent with the

philosophy of the institution of which the training program is a part.

(2) Training program objectives shall identify competencies expected of graduates from the program. Such objectives shall

serve as the basis of program development.

(3) Course objectives shall state expected behavioral outcomes of the student, serve as the basis for course development and

student evaluation, and evidence direct relationship to training program objectives.

(4) All training program objectives shall be reviewed annually by the administration, faculty and students and revised if

necessary.

(1) At a minimum, the faculty of each approved midwifery training program shall be comprised of a licensed midwife who is

actively teaching, and either a certified nurse midwife, or a board certified physician who has actively practiced obstetrics within

the last 4 years.

(2) It shall be the responsibility of the school of midwifery to furnish current faculty information to the department upon

request.

(1) In order to ensure the preparation of midwives capable of competent practice, the curriculum shall be an organized pattern

of classroom instruction and clinical training which is consistent with principles of learning and educational practices, and which

reflects the stated philosophy and objectives of the training program.

(2) Standards for midwifery programs shall encompass classroom instruction and clinical training in all aspects of antepartal,

intrapartal, postpartal, and neonatal care and shall include:

(a) The core competencies established by the American College of Nurse Midwives and the Midwives Alliance of North

America incorporated herein by reference and effective 1-26-94, and can be obtained upon request from the Council of Licensed

Midwifery, Department of Health, 4052 Bald Cypress Way, Bin C06, Tallahassee, Florida 32399-3256; and

(b) A component on the law and rules which govern the practice of midwifery in Florida.

(1) Clinical learning experiences shall be planned and assigned to be sequential to, or simultaneous with classroom instruction.

(2) Clinical learning experiences based on program objectives shall include a variety of settings such as homes, birth centers,

clinics, offices and hospitals.

(3) It shall be the responsibility of the midwifery training program to obtain and maintain current contractual agreements with

each facility utilized for clinical training to insure provision of the appropriate clinical experience necessary to fulfill the

requirements of this chapter.

(4) The faculty shall select clinical learning experiences and provide the student midwife with a variety of preceptor role

models who shall be physically present at every birth and shall be available to the student at all times when the student is

performing in a midwifery capacity with patients. No preceptor shall be assigned more than two students during any clinical

experience.

(5) The student midwife, during training, shall undertake, under the supervision of a preceptor, the care of 50 women in each of

the antepartal, intrapartal and postpartal periods, but the same women need not be seen through all 3 periods. The intrapartum

period includes labor, birth, and the immediate postpartum. No more than five percent (5%) of the required intrapartal

managements shall include transfers in active labor.

(6) During training under the supervision of a preceptor, the student midwife shall undertake the neonatal examination of 50

newborns.

(7) The student midwife shall observe an additional 25 women in the intrapartal period.

(8) Each student midwife shall have a designated program faculty member available for periodic consultation during

preceptorship.

(1) The midwifery school shall specify the lines of authority in the organizational structure governing the program, define its

placement within the institution where the training program is conducted, and demonstrate:

(a) Duties and responsibilities of the director of the program;

(b) Admission, promotion, and retention policies and procedures for students;

(c) Fiscal accountability for the effective operation of the training program;

(d) Provisions for classroom space, laboratories, equipment, library, office space for instructors and administrators;

(e) Library holdings which shall consist of current professional journals and other appropriate holdings as determined by the

midwifery school;

(f) Education materials which shall include a variety of current teaching aids for both group and self instructional use; and

(g) An organized system of record making and record keeping which includes, but not limited to, pertinent information on

students, faculty, preceptors, and facilities relative to classroom instruction and clinical training.

(2) Upon request of a student or a graduate, the institution or the midwifery training program shall furnish a copy of the

student’s final record to the agency within 60 days following the successful completion of the program.

(1) Applicants who are applying for licensure as a midwife pursuant to Rule 64B24-2.004, F.A.C., shall successfully complete

a 4-month pre-licensure course conducted within an approved training program pursuant to Rule 64B24-4.002, F.A.C.

(2) The applicant shall evidence having completed a pre-licensure course which shall include the following:

(a) An official transcript from the institution, or midwifery training program where the course was taken to include course

titles, grade received and dates of the program; or

(b) An original letter on letterhead stationery from the director of the training program which states the applicant successfully

completed the pre-licensure course, the grade earned and the dates of attendance; or

(c) A certificate stating the successful completion of the pre-licensure course and the dates of attendance. Such certificate shall

be signed by the director of the midwifery training program.

(3) To be admitted to the 4-month pre-licensure course, a person shall meet admission requirements as established by the

approved training program and requirements pursuant to Rule 64B24-4.003, F.A.C.

(4) The 4-month pre-licensure course shall be approved by the department and shall include the following:

(a) Content review and demonstration of proficiency in the core competencies established by the American College of Nurse

Midwives and the Midwives Alliance of North America;

(b) Florida Law and Rules Component;

(c) Provisions for 5 supervised labor and deliveries and 10 supervised prenatal visits by each course participant.

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64B24-5.001 Renewal of Midwifery License.

64B24-5.002 Inactive Status. (Repealed)

64B24-5.003 Reactivation of Inactive License.

The department shall renew an active license to practice midwifery upon timely receipt of:

(1) The form affirming compliance with all requirements of renewal;

(2) The appropriate fees required pursuant to Rule Chapter 64B24-3, F.A.C.; and

(3) A written plan for the management of emergencies pursuant to Section 467.017, F.S.

(1) Any person desiring to reactivate an inactive license shall contact the department in writing to request such from the

department.

(2) The department shall reactivate the license of applicants who pay the active status renewal fee, the reactivation fee, the

change of status fee, and if applicable, the delinquency fee, as required by Chapter 64B24-3, F.A.C., and who have met the

continuing education requirement established in Rule 64B24-6.002, F.A.C.

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64B24-6.001 Continuing Education for Biennial Renewal.

64B24-6.002 Continuing Education Requirements for Reactivation.

64B24-6.003 Documentation of Continuing Education Hours.

64B24-6.004 Continuing Education Providers.

64B24-6.005 Criteria for Continuing Education Programs.

64B24-6.006 Performance of Pro Bono Services.

(1) Each midwife licensed pursuant to Chapter 467, F.S., shall complete 20 clock hours of department approved, clinically

related continuing education during the biennium preceding renewal. A clock hour is defined as not less than 50 minutes.

(2) A licensee shall not be required to complete continuing education hours, if the initial license is issued in the second year of

the biennium.

(3) The following courses are required as part of each licensees’ biennial continuing education requirements.

(a) One (1) hour in HIV/AIDS;

(b) One (1) hour in domestic violence;

(c) One (1) hour in the laws and rules governing the Midwifery Practice Act; and

(d) Two (2) hours in medical error prevention.

(1) Each midwife licensed pursuant to Chapter 467, F.S., whose license has been on inactive status for more than 1 year shall

be required to complete continuing education hours as a condition for reactivating the inactive license.

(2) The licensee shall submit to the department evidence of participation in 10 clock hours of department approved, clinically

related continuing education for each year the licensee’s license remained inactive. This requirement is in addition to submitting

evidence of the continuing education required for the previous biennium in which the licensee held an active license.

(1) At the time of renewal, each midwife shall be required to affirm that he or she has the applicable number of continuing

education credit hours pursuant to Rule 64B24-6.001, F.A.C., earned during the most recent biennium.

(2) Each midwife shall be responsible for maintaining proof for a period of 4 years of their continuing education hours used as

a basis for renewal of licensure, and for submitting certified copies of such documentation upon request of the department.

(3) The department will audit the files of randomly selected licensees to ensure compliance pursuant to Rule 64B24-6.001,

F.A.C. Failure to maintain documentation or the submission of false or misleading information or documentation shall subject the

licensee to disciplinary action, pursuant to Section 467.203, F.S.

(1) Any institution, organization, agency or individual seeking approved provider status for the purpose of conducting

continuing education programs for licensed midwives shall apply to the department, by completing Form DH-MQA 1055,

Application for Continuing Education Provider, incorporated herein by reference and revised 8/01, which may be obtained from the

Council of Licensed Midwifery, Department of Health, 4052 Bald Cypress Way, Bin C06, Tallahassee, Florida 32399-3256; and

remitting the provider application fee required by Rule Chapter 64B24-3, F.A.C.

(2) The department shall issue a provider number to all approved providers pursuant to Rule 64B24-6.005, F.A.C. The provider

number shall appear on all documents relating to each continuing education program conducted by the provider.

(3) Approved provider status shall be effective for the biennium in which such status was granted by the department. Provider

status may be renewed upon meeting requirements of Rule 64B24-6.005, F.A.C., completing the form provided by the department,

and remitting the renewal fee pursuant to Rule 64B24-3.001, F.A.C.

(4) Approved providers shall maintain records of each program offering for 4 years following each licensure biennium during

which the program was offered. Program records shall be limited to the following items:

(a) A program outline which reflects its educational objectives;

(b) The instructor’s name;

(c) The date and location of the program;

(d) Participants’ evaluations of the program;

(e) The number of clock hours of credit awarded to each participant; and

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(f) A roster of participants by name and licensure number.

(5) The approved provider shall certify the participation of any midwife who completes the program by providing the midwife

with a certificate or comparable documentation verifying that the midwife completed the program. The verification shall contain:

(a) The provider’s name and provider number;

(b) The title of the program;

(c) The name of the instructor;

(d) The date and location of the program; and

(e) The number of hours of continuing education earned.

(6) Presenters of programs may receive the same amount of credit, on a one time basis, as program participants. The presenters

must have developed the program, been in attendance for the entire program and received documentation of completion from the

approved provider. A maximum of 3 hours of continuing education credit per biennium may be received for presenting programs.

(7) The department retains the right and authority to audit or monitor programs and review records and program materials

given by any provider approved pursuant to this section. The department may rescind provider status or reject individual programs

given by a provider if they do not have clinical relevance to the practice of midwifery, or if any false or misleading information has

been disseminated in connection with the continuing education program, or if the provider has failed to conform to and abide by the

conditions outlined in the application and rules of the department.

(1) Any institution, organization, agency or individual approved by the department to provide continuing education programs

to midwives for the purpose of licensure renewal shall demonstrate such programs comply with the following criteria:

(a) Programs shall have clinical relevance to the practice of midwifery;

(b) Programs shall be at least 1 clock-hour in duration;

(c) Programs shall have an organized structure with objectives and expected outcomes; and

(d) Presenters, instructors and facilitators of programs shall be recognized professionals such as physicians, nurses, certified

nurse midwives, psychologists, or licensed midwives.

(2) The following programs which meet the requirements of subsection (1) of this rule are approved for renewal of license;

(a) Programs sponsored by the American College of Nurse Midwives or the Midwives Alliance of North America;

(b) Programs offered by a midwifery training program approved by the agency pursuant to Rules 64B24-4.002 and

64B24-4.006, F.A.C.;

(c) Programs sponsored by the Public Health Service;

(d) Programs sponsored by the American Red Cross;

(e) American Medical Association (AMA) or American Osteopathic Association (AOA) Category I programs;

(f) Programs sponsored by the American Psychological Association (APA);

(g) Programs sponsored by the American Heart Association;

(h) Programs sponsored by the American Cancer Society; and

(i) Programs sponsored by the National Safety Council.

(j) Courses that have been pre-approved by the Florida Board of Nursing, Florida Board of Medicine, Florida Board of

Osteopathic Medicine, Florida Board of Pharmacy, Florida Board of Psychology, the Dietetic and Nutrition Practice Council of

Florida, and the Florida Board of Clinical Social Work, Marriage and Family Therapy and Mental Health Counseling as it pertains

to the practice of midwifery.

(k) A Florida licensed midwife who resides in another state may obtain the continuing education units required for license

renewal from programs approved by the state agencies which regulate licensure of health care professionals in that state providing

such programs have clinical relevance to the practice of midwifery and meet the requirements of this section.

(l) Videocassette courses up to a maximum of five (5) hours per subject which meet the criteria pursuant to this section.

(m) Programs not specifically approved above shall be considered by the department on an individual basis upon written

request and sufficient documentation to verify that the program meets the requirements pursuant to Rule 64B24-6.005, F.A.C.

(3) To receive approval by the department, courses on domestic violence must be a minimum of 1 hour long, cover the

substantive areas set forth in Section 456.031, F.S., as it pertains to the practice of midwifery, and must be approved by a state or

federal government agency or professional association within the United States or offered by an approved continuing education

provider. Home study courses which meet these requirements will be accepted.

(1) Up to 5 hours, per biennium, of continuing education credit may be fulfilled by the performance of pro bono services to the

indigent or to under served populations or in areas of critical need within the state pursuant to Section 456.013(8), F.S. The standard

for determining indigence shall be that recognized by the Federal Poverty Income Guidelines produced by the United States

Department of Health and Human Services.

(2) In order to receive credit under this rule, licensees must notify the department and receive approval in advance of providing

the services. Credit shall be given on an hour per hour basis. In the formal request to the department, licensees shall disclose the

following:

(a) The type, nature and extent of services to be rendered;

(b) The location where the services will be rendered;

(c) The number of patients expected to be served; and

(d) A statement indicating that the patients to be served are indigent.

If licensees intend to provide services in under-served or critical-need areas, the request for approval shall provide a brief

explanation as to those facts.

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64B24-7.001 Definitions.

64B24-7.002 Qualifications Necessary for Practice. (Repealed)

64B24-7.003 Acceptance of Patients.

64B24-7.004 Risk Assessment.

64B24-7.005 Informed Consent.

64B24-7.006 Preparation for Home Delivery.

64B24-7.007 Responsibilities of Midwives During the Antepartum Period.

64B24-7.008 Responsibilities of Midwives During Intrapartum.

64B24-7.009 Responsibilities of the Midwife During Postpartum.

64B24-7.010 Collaborative Management.

64B24-7.011 Administration of Medicinal Drugs.

64B24-7.012 Emergency Care Plan. (Repealed)

64B24-7.013 Requirement for Insurance.

64B24-7.014 Patient Records.

64B24-7.015 Advertising.

64B24-7.016 Sexual Misconduct.

64B24-7.017 Exemption for Registered Nurses and Certified Nurse-Midwives. (Repealed)

As used in this rule chapter, the term:

(1) "Consultation" means communication between a licensed midwife and a health care provider for the purpose of assessing a

potential or actual problem relevant to the patient.

(2) "Referral" means a request made by a licensed midwife to a physician, or ARNP for an assessment of a patient to determine

management for or a resolution to a problem relating to the health of the patient.

(3) "Transfer" means a formal dissolution of care to the patient by a licensed midwife which results in such care being assumed

by another health care provider.

Midwives shall accept for services only those patients expected to have a normal pregnancy and childbirth pursuant to Rule

64B24-7.004, F.A.C.

(1) For each patient, the licensed midwife shall assess risk status criteria for acceptance and continuation of care. The general

health status and risk assessment shall be determined by the licensed midwife by obtaining a detailed medical history, performing a

physical examination, and taking into account family circumstances along with social and psychological factors. The licensed

midwife shall risk screen potential patients using the criteria in this section. If the risk factor score reaches 3 points the midwife

shall consult with a physician who has obstetrical hospital privileges and if there is a joint determination that the patient can be

expected to have a normal pregnancy, labor and delivery the midwife may provide services to the patient.

(2) The licensed midwife shall continue to evaluate a patient during the antepartum, intrapartum and postpartum. If the

cumulative risk score reaches three points or higher and the patient is not expected to have a normal pregnancy, labor and delivery,

the midwife shall transfer such patient out of his or her care. The midwife may provide collaborative care to the patient pursuant to

Rule 64B24-7.010, F.A.C.

(3) The risk factors shall be scored as follows: Score

(a) Socio-Demographic Factors.

1. Chronological age under 16, or older than 40. 1

2. Residence of anticipated birth more than 30 minutes from emergency care. 3

(b) Documented Problems in Maternal Medical History.

1. Cardiovascular System

a. Chronic hypertension. 3

b. Heart disease. 3

(i) Heart disease assessed by a cardiologist which places the mother or fetus at no risk. 1

c. Pulmonary embolus. 3

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d. Congenital heart defects. 3

(i) Congenital heart defects assessed by a cardiologist which places the mother or fetus at no risk. 1

2. Urinary System

a. Renal disease. 3

b. History of pyelonephritis. 1

3. Psycho-Neurological

a. History of psychotic episode adjudged by psychiatric evaluation and which required use of drugs related to its

management, but not currently on medication.

1

b. Current mental health problems

requiring drug therapy. 3

c. Epilepsy or seizures in the last two years. 3

d. Required use of anticonvulsant drugs. 3

e. During the current pregnancy, drug or alcohol addiction, use of addicting drugs.

f. Severe undiagnosed headache. 3

4. Endocrine System

a. Diabetes mellitus. 3

b. History of gestational diabetes. 1

c. Current thyroid disease.

(i) Euthyroid. 1

(ii) Non-Euthyroid 3

5. Respiratory System

a. Chronic bronchitis. 1

(i) Current or chronic or with medication. 3

(ii) Without medication or current problems. 1

c. Smoking.

(i) 10 or less cigarettes per day. 1

(ii) More than 10 cigarettes per day. 3

6. Other Systems

a. Bleeding disorder or hemolytic disease. 3

b. Cancer of the breast in the past five years. 3

7. Documented Problems in Obstetrical History

a. Expected Date of Delivery (EDD) less than 12 months from date of previous delivery. 1

b. Previous Rh sensitization. 3

c. 5 or more term pregnancies. 3

d. Previous abortions.

(i) 3 or more consecutive spontaneous abortions. 3

(ii) Two consecutive spontaneous abortions or more than three spontaneous abortions. 1

(iii) 1 septic abortion. 3

e. Uterus.

(i) Incompetent cervix, with related medical treatment. 3

(ii) Prior uterine surgery 3

f. Previous placenta abruptio. 3

g. Previous placenta previa. 1

h. Severe pregnancy induced hypertension during last pregnancy. 2

i. Postpartum hemorrhage apparently unrelated to management. 3

8. Physical Findings of Previous Births

a. Stillbirth occurring at more than 20 weeks gestation or neonatal loss (other than cord accident). 3

b. Birthweight.

(i) Less than 2500 grams or two or more previous premature labors without a subsequent low risk pregnancy and

full term appropriate for gestational age (AGA) infant.

3

(ii) Less than 2500 grams or two or more previous premature labors with one or more full term AGA infant(s)

subsequently delivered, after a low risk pregnancy.

1

(iii) More than 4000 grams.

c. Major congenital malformations, genetic, or metabolic disorder. 3

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9. Maternal Physical Findings

a. Gestation.

(i) Of more than 22 weeks in the patient’s first pregnancy (nullipara), unless the patient provides a copy of a

medical record documenting a prenatal physical examination and prenatal care by a licensed physician, advanced

registered nurse practitioner, or licensed midwife trained in obstetrics and gynecology who regularly provides maternity

care.

3

(ii) Of more than 28 weeks if the patient has had at least one previous viable birth (multipara), unless the patient

provides a copy of a medical record documenting a prenatal physical examination and prenatal care by a licensed

physician, advanced registered nurse practitioner, or licensed midwife trained in obstetrics and gynecology who

regularly provides maternity care.

3

b. Prepregnant weight is not within the range of the following weights by height: 2

Height in Inches Prepregnant Minimum Prepregnant Maximum

Without Shoes Weight in Pounds Weight in Pounds

56 83 143

57 85 146

58 86 150

59 89 153

60 92 157

61 95 161

62 97 166

63 100 170

64 103 175

65 106 180

66 110 185

67 113 190

68 117 196

69 121 202

70 124 208

71 128 212

72 131 217

73 135 222

c. Evidence of clinically diagnosed pathological uterine myoma or malformations, abdominal or adnexal masses. 3

d. Polyhydramnios or oligohydramnios.

(i) Prior pregnancy. 2

(ii) Current pregnancy. 3

e. Cardiac diastolic murmur, systolic murmur grade III or above, or cardiac enlargement. 3

10. Current Laboratory Findings

a. Hematocrit/Hemoglobin.

(i) Less than 31% or 10.3 gm/100 ml. 1

(ii) Less than 28% or 9.3 gm/100 ml. 3

b. Sickle cell anemia. 3

c. Pap smear suggestive of dysplasia. 3

d. Evidence of active tuberculosis. 3

e. Positive serologic test for syphilis confirmed active. 3

f. HIV positive. 3

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(1) A licensed midwife shall obtain a patient’s consent for the provision of midwifery services. Such consent shall be recorded

on the Informed Consent for Licensed Midwifery Services, Form DH-MQA 1047, revised 3/01, which is hereby adopted and

incorporated by reference, and can be obtained from the Council of Licensed Midwifery, 4052 Bald Cypress Way, BIN #C06,

Tallahassee, Florida 32399-3256.

(2) To complete the consent form, the licensed midwife shall inform the patient of:

(a) The licensee’s qualifications to perform the services rendered.

(b) The nature and risks of the procedures to be used.

(c) The advantages of the procedures to be used.

(d) Professional liability insurance status.

(3) A signed copy of the consent form shall be placed in the patient’s record.

(1) For home births, the licensed midwife shall:

(a) Encourage each patient to have medical care available by a health care practitioner experienced in obstetrics throughout the

prenatal, intrapartal and postpartal periods, and

(b) Make a home visit by 36 weeks of pregnancy. The licensed midwife shall ensure that the setting in which the infant is to be

delivered is safe, clean and conducive to the establishment and maintenance of health.

(2) The midwife shall prepare or cause to be prepared the following facilities to be used for delivery:

(a) The area used for labor shall be cleaned, well lighted, well ventilated and close to the toilet.

(b) The delivery area should be large enough to allow ample work space and provide privacy.

(c) The delivery area must be organized, well lighted, clean, free from drafts and insects, near handwashing facilities and clear

of unnecessary furnishings.

(d) A safe, clean sleeping arrangement for the infant.

(3) The midwife shall instruct the expectant parents and ensure that appropriate supplies are on hand for use by the mother and

infant at the time of delivery and early postpartum.

(4) The midwife shall have the following equipment and supplies clean and ready for use at delivery:

(a) Sterile obstetrical pack.

(b) Bulb syringe.

(c) Oxygen.

(d) Eye prophylaxis pursuant to Section 383.04, F.S.

(1) The licensed midwife shall: Require each patient to have a complete history and physical examination which includes:

1. Pap smear.

2. Serological screen for syphilis.

3. Gonorrhea and chlamydia screening.

4. Blood group including Rh factor and antibody screen.

5. Complete blood count (CBC).

6. Rubella titer.

7. Urinalysis with culture.

8. Sickle cell screening for at risk population.

9. Screen for hepatitis B surface antigen (HBsAG).

(b) Conduct the Healthy Start Prenatal Screen interview or assure that each patient has been previously screened.

(c) Provide counseling and offer screening related to the following:

1. Neural tube defects.

2. HIV/AIDS.

3. Group B Streptococcus.

4. CVS or genetic amniocentesis for women 35 years of age or older at the time of delivery.

5. Nutritional counseling.

6. Childbirth preparation.

7. Risk Factors.

8. Common discomforts of pregnancy.

9. Danger signs of pregnancy.

(d) Follow-up screening:

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1. Hematocrit or hemoglobin levels at 28 and 36 weeks gestation.

2. Diabetic screening between 24 and 28 weeks gestation.

3. Antibody screen for Rh negative mothers, at 28 weeks gestation. Counsel and encourage RhoGAM prophylaxis. In those

clients declining RhoGAM prophylaxis repeat antibody screen at 36 weeks.

(e) Require prenatal visits every four weeks until 28 weeks gestation, every two weeks from 28 to 36 weeks gestation and

weekly from 36 weeks until delivery.

(2) The following procedures and examinations shall be completed and recorded at each prenatal visit:

(a) Weight.

(b) Blood pressure.

(c) Urine dip stick for protein and glucose each visit with leukocytes, ketones, and nitrites as indicated.

(d) Fundal height measurements.

(e) Fetal heart tones and rate.

(f) Assessment of edema and patellar reflexes, when indicated.

(g) Indication of weeks’ gestation and size correlation.

(h) Determination of fetal presentation after 28 weeks of gestation.

(i) Nutritional assessment.

(j) Assessment of subjective symptoms of PIH, UTI and preterm labor.

(3) An assessment of the Expected Date of Delivery (EDD) and gestational age shall be done by 20 weeks, if practical,

according to:

(a) Last normal menstrual period.

(b) Reference to the statement of uterine size recorded during the initial exam.

(c) Hearing fetal heart tones at eleven weeks with a Doppler unit, if one is available, and patient gives consent.

(d) Recording of quickening date.

(e) Recording weeks of gestation by dates and measuring in centimeters the height of the uterine fundus.

(f) Hearing the fetal heart tones at twenty weeks with a fetoscope.

(4) If a reliable EDD cannot be established by the above criteria, then the licensed midwife shall encourage the patient to have

an ultrasound for EDD.

(5) The midwife shall refer a patient for consultation to a physician with hospital obstetrical privileges if any of the following

conditions occur during the pregnancy:

(a) Hematocrit of less than 33% at 37th week gestation or hemoglobin less than 11 gms/100 ml.

(b) Unexplained vaginal bleeding.

(c) Abnormal weight change defined as less than 12 or more than 50 pounds at term.

(d) Non-vertex presentation persisting past 37th week of gestation.

(e) Gestational age between 41 and 42 weeks.

(f) Genital herpes confirmed clinically or by culture at term.

(g) Documented asthma attack.

(h) Hyperemesis not responsive to supportive care.

(i) Any other severe obstetrical, medical or surgical problem.

(6) The midwife shall transfer a patient if any of the following conditions occur during the pregnancy:

(a) Genetic or congenital abnormalities or fetal chromosomal disorder.

(b) Multiple gestation.

(c) Pre-eclampsia.

(d) Intrauterine growth retardation.

(e) Thrombophlebitis.

(f) Pyelonephritis.

(g) Gestational diabetes confirmed by abnormal glucose tolerance test.

(h) Laboratory evidence of Rh sensitization.

(7) If the conditions listed pursuant to this section are resolved satisfactorily and the physician and midwife deem that the

patient is expected to have a normal pregnancy, labor and delivery, then the care of the patient shall continue with the licensed

midwife.

(1) Upon initial assessment, the midwife shall:

(a) Determine onset of labor.

(b) Review patient’s prenatal records.

(c) Assess condition of the mother and fetus.

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(d) Assess delivery environment.

(e) Perform sterile vaginal examinations to initially assess cervical dilation and effacement, presentation, position and station

of the fetus, and the status of the membranes.

(2) Throughout active labor the midwife shall:

(a) Maintain a safe and hygienic environment.

(b) Provide nourishment, rest and support as indicated by patient’s condition.

(c) Monitor, assess and record the status of labor and the maternal and fetal condition.

(d) Measure the blood pressure every hour unless significant changes or symptoms require more frequent assessments.

(e) Take the patient’s pulse every 2 hours while membranes are intact and temperature is normal, then every hour after rupture

of membranes.

(f) Take the temperature every 4 hours, or more frequently if maternal condition warrants, and every hour if elevated to 100º F

or above.

(g) Estimate fluid intake and urinary output at least every 2 hours.

(h) Assess for hydration and edema.

(3) The midwife shall assess and record the status of labor as follows:

(a) Measure the frequency, duration and intensity of the contractions every half hour and more frequently if indicated.

(b) Observe and record vaginal discharge.

(c) Monitor fetal heart tones during and following contractions to assess fetal condition according to the following schedule

after admission to care for labor:

1. Every hour during the latent phase.

2. Every 30 minutes during the active phase of the first stage.

3. Every 15 minutes during transition.

4. Every five minutes during the second stage.

5. Immediately after the appearance of amniotic fluid in the vaginal discharge.

(d) Palpate the abdomen for the position and level of the presenting part.

(e) Perform sterile vaginal examinations to assess cervical dilation and effacement, presentation, position and station of the

fetus, and the status of the membranes.

(4) Risk factors shall be assessed throughout labor to determine the need for physician consultation or emergency transport.

The midwife shall consult, refer or transfer to a physician with hospital obstetrical privileges if the following occur during labor,

delivery or immediately thereafter:

(a) Premature labor, meaning labor occurring at less than 37 weeks of gestation.

(b) Premature rupture of membranes, meaning rupture occurring more than 12 hours before onset of regular active labor.

(c) Non-vertex presentation.

(d) Evidence of fetal distress.

(e) Abnormal heart tones.

(f) Moderate or severe meconium staining.

(g) Estimated fetal weight less than 2500 grams or greater than 4000 grams.

(h) Pregnancy induced hypertension which is defined as 140/90, or an increase of 30 mm hg systolic or 15 mm hg diastolic

above baseline.

(i) Failure to progress in active labor:

1. First stage: lack of steady progress in dilation and descent after 24 hours in primipara and 18 hours in multipara.

2. Second stage: more than 2 hours without progress in descent.

3. Third stage: more than 1 hour.

(j) Severe vulvar varicosities.

(k) Marked edema of cervix.

(l) Active bleeding.

(m) Prolapse of the cord.

(n) Active infectious process.

(o) Other medical or surgical problems.

(5) The midwife shall not perform any operative procedure other than:

(a) Artificial rupture of the membranes when the fetal head is engaged and well applied to the cervix in active labor and four or

more centimeters dilated.

(b) Clamping and cutting the umbilical cord.

(c) Episiotomy when indicated.

(d) Suture to repair first and second degree lacerations.

(6) The midwife shall not attempt to correct fetal presentations by external or internal version.

(7) The midwife shall use only prescription drugs pursuant to Rule 64B24-7.011, F.A.C.

(8) The midwife shall not use artificial, forcible or mechanical means to assist the birth.

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(1) Care of the newborn shall include:

(a) Clearing the airway of mucus.

(b) Clamping and cutting the umbilical cord.

(c) Obtaining a cord blood sample for laboratory testing for type, Rh Factor, and direct Coombs test when the mother is Rh

negative.

(d) Assessing the newborn’s condition according to Apgar scoring at one (1) minute and five (5) minutes and record the results

of each assessment.

(e) Weighing the infant.

(f) Instilling prophylaxis into each eye or retain the written objection pursuant to Section 383.04 and 383.06, F.S.

(g) Administering vitamin K prophylaxis.

(h) Examining the newborn and reporting any abnormalities or problems to the physician including low Apgar score.

(i) Providing for infant bonding with parent.

(2) The midwife shall consult, refer or transfer the infant to a physician if any of the following conditions occur:

(a) Apgar score less than 7 at 5 minutes.

(b) Signs of pre- or post-maturity.

(c) Weight: if less than 2500 grams.

(d) Jaundice.

(e) Persistent hypothermia, meaning a body temperature of less than 97º F rectal after 2 hours of life.

(f) Respiratory problem.

(g) Exaggerated tremors.

(h) Major congenital anomaly.

(i) Any condition requiring more than 4 hours of postdelivery observation.

(3) Care of the mother shall include:

(a) Observation for signs of hemorrhage.

(b) Inspection of the expelled placenta to insure that it is intact and free from defects or abnormalities.

(c) Palpation of the fundus to insure that it is firm.

(d) The midwife shall instruct the mother in self care and care of the infant including feeding and cord care.

(4) The midwife must remain with the mother and infant for at least 2 hours postpartum, or until both the mother’s and infant’s

conditions are stable, whichever is longer. Maternal stability is evidenced by normal blood pressure, pulse, respirations, bladder

functioning, fundus firm and lochia normal. Infant stability is evidenced by established respirations, normal temperature, and strong

sucking.

(5) If any complications arise, such as a retained placenta or postpartum hemorrhage, the midwife shall consult with a

physician, or transport the patient for emergency medical care dependent upon the urgency of the situation.

(6) A follow-up visit shall be made between 24 and 48 hours following delivery, unless conditions warrant an earlier visit. The

midwife may arrange for such a visit to be made by a physician, certified nurse midwife, registered nurse, or another licensed

midwife. The patient shall be instructed to have a postpartum examination within 6 to 8 weeks after delivery or sooner if any

abnormalities exist or problems arise.

(7) If the mother is Rh negative, the midwife shall obtain the laboratory tests results of the cord blood studies, and if the infant

is Rh positive, assure and document that the mother receives Rho immune globulin within 72 hours of the delivery.

(8) The midwife shall instruct the parents regarding the requirement for the infant screening blood test for metabolic disorders.

If arrangements for this screening have not been made, the midwife shall notify the county health unit or retain the written objection

pursuant to Section 383.14, F.S.

(9) The midwife shall conduct the Healthy Start Postnatal Screening for the infant or assure that it will be done.

(10) Within 5 days following each birth, form DH 511, Certificate of Live Birth, available from the local county health

department, must be completed and submitted to the local registrar of vital statistics.

(a) For births occurring in a hospital, birth center or other health care facility, or en route thereto, the person in charge of the

facility is responsible for the preparation and filing of the certificate, and for certifying the facts of the birth therein. Within 48

hours of the birth, the midwife shall provide the facility with the medical information required for the birth certificate.

(b) For births occurring outside a facility wherein a licensed midwife is in attendance during or immediately after the delivery,

the midwife shall prepare and file the certificate.

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(1) A midwife may provide collaborative prenatal and postpartal care to women not expected to have a normal pregnancy,

labor and delivery with a physician who holds hospital obstetrical privileges maintaining supervision for directing the specific

course of medical treatment.

(2) Prior to engaging in collaborative management, the licensed midwife shall:

(a) Provide and document to the department that the midwife successfully completed a course on collaborative management

within an approved training program.

(b) Enter into a written protocol with a physician licensed under Chapter 458 or 459, F.S., who is actively practicing obstetrics

and has hospital obstetrical privileges. The protocol shall be made on the Collaborative Management Agreement form which is

incorporated by reference herein, effective 7-14-94, and can be obtained from the Council of Licensed Midwifery, Department of

Health, 4052 Bald Cypress Way, Bin #C06, Tallahassee, Florida 32399-3256 and shall at a minimum contain:

1. Name, address and telephone number of patient.

2. Name, address and telephone number of midwife.

3. Name, address and telephone number of physician who will maintain supervision for directing the specific plan of medical

treatment as outlined in the protocol.

4. Identification of factors.

5. Rationale of the deviation from the low-risk criteria.

6. Specific course of management and expected outcome.

7. Criteria for the discontinuance of the collaborative agreement.

(c) The protocol shall be signed and dated by the patient, licensed midwife and physician. A copy of the collaborative

agreement shall be placed and maintained in the patient’s record.

(d) The midwife shall provide the physician with a complete copy of all patient records pertaining to this pregnancy.

(3) A licensed midwife practicing within a health care facility or under the supervision of a physician group shall establish a

written collaborative management protocol prior to providing prenatal and postnatal care to women not expected to have a normal

pregnancy, labor, or delivery. The written protocol shall:

(a) Be maintained on the premises of the health care facility,

(b) Be updated at least annually,

(c) Be readily accessible to the midwife and physician,

(d) Include a plan for access to complete obstetrical services, and

(e) Be acceptable in lieu of a patient’s specific collaborative management agreement.

(1) A midwife licensed prior to October 1, 1992, may administer certain medicinal drugs during intrapartal, postpartal and

neonatal care, if prior to administering such drugs, the licensee has successfully completed a course in the practice of administering

medicinal drugs within an approved training program.

(2) A midwife may administer only those drugs which have been prescribed by a physician licensed under Chapter 458 or 459,

F.S., pursuant to Chapter 499, F.S., and dispensed at a pharmacy permitted by Chapter 465, F.S., and by a pharmacist licensed

pursuant to Chapter 465, F.S.

(3) The midwife may administer the following:

(a) Postpartum oxytocics.

(b) Prophylactic ophthalmic medication.

(c) Oxygen.

(d) Vitamin K.

(e) RhO Immune Globulin.

(f) Local anesthetic.

(g) Other medications as prescribed by the physician.

(4) After administering any medicinal drug, the midwife shall document in the medical record of the patient the type of drug(s)

administered, name of drug, dosage, method of administration, injection site, or topical, the date and time, and the drug’s effect.

(1) Except as provided herein, applicants for licensure, applicants for licensure reactivation, and applicants for licensure

renewal shall at the time of application submit proof of professional liability insurance coverage in an amount not less than

$100,000 per claim, with a minimum annual aggregate of not less than $300,000 from an authorized insurer as defined under

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Section 624.09, F.S., from a surplus lines insurer as defined under Section 626.914, F.S., from a risk retention group as defined

under Section 627.942, F.S., from the Joint Underwriting Association established under Section 627.351(4), F.S., or through a plan

of self-insurance as provided in Section 627.357, F.S.

(2) A licensed midwife who practices exclusively as an officer, employee, or agent of the Federal Government or the state or

its agencies or subdivisions shall submit proof to the department that coverage equivalent to or exceeding this section is maintained

by her employer on her behalf. For purposes of this subsection, an agent of the state, its agencies, or its subdivisions is a person who

is eligible for coverage under any self-insurance or insurance program authorized by the provisions of Section 768.28(15), F.S., or

who is a volunteer under Section 110.501(1), F.S.

(3) A licensed midwife who practices only in conjunction with teaching duties at an approved midwifery school shall submit

proof to the department that coverage equivalent to or exceeding this section is maintained by her employer on her behalf. A

licensed midwife may engage in the practice of midwifery only to the extent that such practice is incidental to and a necessary part

of duties in conjunction with the teaching position in the school unless the midwife provides proof of coverage as provided by

subsection (1) or (2).

(4) A licensed midwife who does not practice midwifery in this state shall submit written proof to the department that the

licensed midwife does not practice midwifery and shall be required to submit proof of professional liability coverage as required by

this section to the department at least 15 days prior to practicing midwifery in this state.

(1) The midwife shall keep a record of each patient served. Such record shall contain:

(a) Name, address and telephone number of patient.

(b) The informed consent form and all documentation of all care given during the prenatal, intrapartum and postpartum period

relevant to midwifery services.

(c) The emergency care plan.

(d) Documentation of all consultations, referrals, transport, transfer of care and emergency care rendered, and all subsequent

updates.

(e) A copy of form DH511, Certificate of Live Birth, submitted to the registrar of vital statistics pursuant to Section

467.019(1), F.S.

(2) The patient’s records shall be kept on file for a minimum of 5 years from date of last entry in records.

(3) Patient records are confidential and may not be released unless authorized by the patient in writing. This confidentiality

prohibits review of the records by a licensed midwife other than the midwife of record or by other health care providers unless they

are actually involved in care or treatment of the patient. Maintenance of patient records by a deceased licensed midwife’s estate,

authorized agent of the estate or by a successor-owner midwife of a practice does not authorize review of patient records. However,

limited review for the purpose of obtaining a patient’s name, address and last date of treatment in order to comply with this rule is

permitted.

(4) Within 90 days of a midwife’s death, the midwife’s estate or agent shall place all patient records of the deceased midwife in

the care of another Florida licensed midwife.

(a) The patient records of the deceased midwife shall be maintained and made available to patients for a period of 5 years.

(b) Within 90 days of a midwife’s death the midwife’s estate or agent shall cause a notice to be published in the newspaper of

greatest general circulation in the county where the midwife practiced which advises patients of the licensed midwife’s death. The

notice shall advise patients that they may obtain copies of their medical records and specify the name, address and telephone

number of the person from whom the copies of records may be obtained. The notice shall appear at least once a week for four

consecutive weeks.

(c) The subsequent Florida licensed midwife shall cause to be published a similar notice whenever the patient records of the

deceased midwife are subsequently transferred to another Florida licensed midwife if such transfer is within 5 years of the

midwife’s death.

(d) During the five year retention period required by this rule each Florida licensed midwife who is in possession of the

deceased midwife’s patient records shall insure that the original patient records, or in cases where the patient has requested that the

records be released or transferred, copies thereof remain in their possession.

(5) Medical records of a licensed midwife who is terminating or relocating their private practice shall be retained by the

licensed midwife or their authorized agent, which may be a successor-owner midwife, and made available to patients for 5 years

from the date of the last entry in the records.

(6) Within one month of a licensed midwife’s termination of practice or relocation of practice outside the local telephone

directory service area of their current practice, a notice shall be published in the newspaper of greatest general circulation in the

county where the midwife practiced which advises patients of the midwife’s termination of practice or relocation. The notice shall

advise patients that they may obtain copies of their medical records and specify the name, address and telephone number of the

person from whom copies of records may be obtained. The notice shall appear at least once a week for 4 consecutive weeks.

(7) Records shall be made available at a location within the county where the midwife practices or practiced and shall be made

available at reasonable times.

(8) When a licensed midwife has been employed by a practice or facility such as a birth center and the laws and rules of that

practice/facility maintain that the patients’ records belong to the facility, the licensed midwife shall be allowed to review on the

premises of the practice/facility the patients records as needed for statistical information pursuant to Sections 467.004(3)(e) and

456.071, F.S., or, the facility may provide the required information in writing to the licensed midwife at reasonable and customary

cost to the midwife pursuant to Section 119.08, F.S.

(1) The department permits advertising by licensed midwives regarding the practice of licensed midwifery in accordance with

the council’s rules so long as such information is in no way fraudulent, false, deceptive or misleading.

(2) No licensed midwife shall disseminate or cause the dissemination of any advertisement or advertising which is in any way

false, deceptive, or misleading. Any advertisement or advertising shall be deemed by the department to be false, deceptive, or

misleading if it:

(a) Contains a misrepresentation of facts; or

(b) Makes only a partial disclosure of relevant facts; or

(c) Creates false or unjustified expectations of beneficial assistance; or

(d) Appeals primarily to a layperson’s fears, ignorance, or anxieties; or

(e) Contains any representation or claims as to which the licensed midwife referred to in the advertising does not expect to

perform; or

(f) Contains any representation, statement, or claim which misleads or deceives; or

(g) Could lead a reasonable prudent person to believe that the licensed midwife is licensed to practice medicine when not so

licensed in the state of Florida.

(3) As used in the rules of this council, the terms "advertisement" and "advertising" shall mean any statements, oral or written,

disseminated to or before the public or any portion thereof, with the intent of furthering the purpose, either directly or indirectly, of

selling professional services, or offering to perform professional services, or inducing members of the public to enter into any

obligation relating to such professional services.

The licensed midwifery-patient relationship is founded on mutual trust. Sexual misconduct in the practice of licensed midwifery

means violation of the midwife-patient relationship in which the licensed midwife uses the relationship to induce or attempt to

induce the patient to engage, or to engage or attempt to engage the patient, in sexual activity outside the scope of the practice or the

scope of generally accepted examination or treatment of the patient. Sexual misconduct in the practice of licensed midwifery is

prohibited and shall be subject to disciplinary action.

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64B24-8.001 Investigation of Complaints.

64B24-8.002 Disciplinary Action and Guidelines.

The department shall investigate all complaints against any licensee whom it regulates under Chapter 467, Florida Statutes. When

the department finds a licensee has committed any of the acts set forth in Section 467.203, Florida Statutes, it shall issue a final

order imposing appropriate penalties within the ranges recommended in the disciplinary guidelines.

(1) The department shall take into consideration the following factors in determining the appropriate disciplinary action to be

imposed:

(a) The severity of the offense;

(b) The danger to the public;

(c) The number of repetitions of offenses;

(d) The length of time since date of violation;

(e) The number of disciplinary actions taken against the licensee;

(f) The length of time licensee has practiced;

(g) The actual damage, physical or otherwise, to the patient;

(h) The deterrent effect of the penalty imposed;

(i) Any efforts for rehabilitation;

(j) Any other mitigating or aggravating circumstances.

(2) The following acts shall be grounds for disciplinary action as set forth in this rule:

(a) Procuring, attempting to procure, or renewing a license to practice midwifery by bribery, by fraudulent misrepresentation,

or through an error of the department.

(b) Having a license to practice midwifery revoked, suspended, or otherwise acted against, including being denied licensure,

by the licensing authority of another state, territory, or country.

(c) Being convicted or found guilty, regardless of adjudication, in any jurisdiction of a crime which directly relates to the

practice of midwifery or to the ability to practice midwifery. A plea of nolo contendere shall be considered a conviction for

purposes of this provision.

(d) Making or filing a false report or record, which the licensee knows to be false; intentionally or negligently failing to file a

report or record required by State or federal law; or willfully impeding or obstructing such filing or inducing another to do so. Such

reports or records shall include only those which are signed in the midwife’s capacity as a licensed midwife.

(e) Advertising falsely, misleadingly, or deceptively.

(f) Engaging in unprofessional conduct, which includes, but is not limited to, any departure from, or the failure to conform to,

the standards of practice of midwifery as established by the department, in which case actual injury need not be established.

(g) Being unable to practice midwifery with reasonable skill and safety to patients by reason of illness; drunkenness; or use of

drugs, narcotics, chemicals, or other materials or as a result of any mental or physical condition. A midwife affected under this

paragraph shall, at reasonable intervals, be afforded an opportunity to demonstrate the ability to resume the competent practice of

midwifery with reasonable skill and safety.

(h) Failing to report to the department any person who the licensee knows is in violation of this chapter or of the rules of the

department.

(i) Willfully or repeatedly violating any provision of this chapter, any rule of the department, or any lawful order of the

department previously entered in a disciplinary proceeding or failing to comply with a lawfully issued subpoena of the department.

(j) Knowingly or willfully allowing a midwifery student to practice midwifery without a preceptor present, except in an

emergency.

(k) Using the title "midwife", "licensed midwife" or any other title or designation which implies that a person is licensed to

practice midwifery, unless such a person is duly licensed as provided in this chapter or in Chapter 464, Florida Statutes.

(l) Knowingly concealing information relating to the enforcement of this chapter or rules adopted pursuant thereto.

(3) When the department finds any person guilty of any of the grounds set forth in Section 467.203, Florida Statutes, it may

enter an order imposing one or more of the following penalties:

(a) Revocation;

(b) Suspension of a license not to exceed 60 days;

(c) Imposition of administrative fine not to exceed $1000 for each count or separate offense:

1. If an applicant for licensure by endorsement has worked as a midwife in Florida prior to applying for licensure in Florida.

2. If an applicant for reactivation has worked while on inactive status.

(d) Issuance of a reprimand;

(e) Placing the midwife on probation for a period of time subject to such conditions as the department may specify;

(f) Requiring the midwife to submit to one or more of the following requirements:

1. Requiring the midwife to submit to treatment.

2. Requiring the midwife to attend continuing education courses.

3. Requiring the midwife to submit to reexamination, and to work under the supervision of a preceptor as defined in subsection

64B24-4.001(12), F.A.C.

(4) The following guidelines shall be used for the disposition of disciplinary cases involving specific types of violations:

(a) For failure to submit, upon request, to the department any reports relating to the practice of midwifery. For a first offense, a

reprimand and a fine up to $100 per offense; as a second offense, probation and a fine up to $200; and as a third offense, suspension

and a fine up to $500 per offense; or any combination thereof.

(b) For intentional misrepresentation of facts regarding:

1. Reports of patient care.

2. Patient records.

3. Informed consent forms.

4. Birth certificates.

5. Emergency treatment.

6. Any information on an application for licensure or renewal. For a first offense, a reprimand, a fine up to $100, and probation

or suspension; as a second offense, probation or revocation and a fine up to $200; and as a third offense, revocation and a fine up to

$500 per offense; or any combination thereof.

(c) For violations related to standards of practice regarding:

1. Accepting patients at risk without consultation pursuant to subsections 64B24-7.004(1) and (2), F.A.C.

2. Administering medications or treatment not permitted by rule or law.

3. Any act of negligence or departure from standards of practice established by law or rule.

4. Permitting unlicensed persons to practice midwifery as defined under Section 467.003(8), Florida Statutes, except in an

emergency or unless the licensed midwife is precepting a student enrolled in an approved midwifery program. For a first offense, a

reprimand, a fine up to $200, probation or suspension; for a second offense, probation and a fine up to $400 per offense, a

requirement to work under the supervision of a preceptor during probationary period until deemed safe to practice alone or

revocation, or any combination thereof; for a third offense, a fine up to $1000 and revocation.

(d) Failure to report any person known to be in violation of the midwifery act or rules, or false, deceptive, or misleading

advertising: For a first offense, a reprimand and a fine up to $200 per offense; as a second offense, probation or suspension and a

fine up to $400 per offense, or any combination thereof; as a third offense, a fine up to $1000 and revocation.

(e) Procuring or renewing a license through fraud will include a penalty of denial of license and a fine up to $1000.

(f) Non-compliance with the rules of Public-Health and Maternal-Infant Hygiene:

1. Failure to use eye prophylaxis or to indicate reason for same pursuant to paragraph 64B24-7.009(1)(f), F.A.C.

2. Failure to file certificates of live birth with the local registrar pursuant to subsection 64B24-7.009(9), F.A.C.

3. Failure to inform parents of infant metabolic screening as required in subsection 64B24-7.009(8), F.A.C. For a first offense,

a reprimand and a fine up to $100 per offense; for a second offense, probation and a fine up to $200 per offense; for a third offense,

suspension or revocation and a fine up to $500 per offense.

(g) For violations related to standards for training by Midwifery Schools: For a first offense, a reprimand with a corrective

action plan to be implemented within 90 days and a penalty of $50 for each day such violation continues without correction; as a

second offense, failure to take corrective action will result in suspension of training activities and a fine of $100 for each day such

violation continues; as a third offense, repeat violations will result in permanent cessation of training activities and a fine not to

exceed $1000.